TriCare makes my head hurt

noah-bear · January 2012

DS is really sick, we moved here in Nov and I have no clue where to take him. Ugh. Thankfully we have meds here at home to buy us time for me to figure all this out.

FormerlyKrista555 · January 2012

Have you called Tricare directly? They can tell you where to go.

GL!

pesci12 · January 2012

Did your DH enroll you and your family in your Tricare region? Do you know if you are you prime or standard? Are you close to an MTF? You can go to the Tricare office on base to find out who you are empanelled to. Or, like PP said just call Tricare.

noah-bear · January 2012

He's in Prime and has to go down to Walter Reed, which is aggravating because 1)I've never been there and 2) it's about an hour drive for us.

I just wish he could see a Dr closer to here.

emolm · January 2012

If you know where to take him and feel he needs to be seen, then you should go.

While you're there, go to Tricare and submit a PCM change request for someone closer to your house. If they approve it, he's still Prime and you get what you want. If they don't approve it, then either switch to Standard or put your big girl panties on.

noah-bear · January 2012

emolm:
put your big girl panties on.

Really? Wow, that was really a stupid reason to pull out the BGP card.....

hopefulmom81 · January 2012

emolm:
If you know where to take him and feel he needs to be seen, then you should go.

While you're there, go to Tricare and submit a PCM change request for someone closer to your house. If they approve it, he's still Prime and you get what you want. If they don't approve it, then either switch to Standard or put your big girl panties on.

Did you see the phrase BGP somewhere and decide you wanted to use the phrase and just randomly busted it out here? OP had an honest question and it was completely unnecessary to be rude. Not cool.

mundayem · January 2012

emolm:
If you know where to take him and feel he needs to be seen, then you should go.

While you're there, go to Tricare and submit a PCM change request for someone closer to your house. If they approve it, he's still Prime and you get what you want. If they don't approve it, then either switch to Standard or put your big girl panties on.

Really??? WTF????

noah-bear · January 2012

BGP...I haz em

lauren2_00@yahoo.com · January 2012

Have you considered Standard? I switched to it when my husband deployed the first time and the closest MTF was about an hour and a half away. The co-pays are reasonable and it'll save you a lot of time and money spent in the car trying to get down to Walter Reed.

noah-bear · January 2012

lauren2_00@yahoo.com:
Have you considered Standard? I switched to it when my husband deployed the first time and the closest MTF was about an hour and a half away. The co-pays are reasonable and it'll save you a lot of time and money spent in the car trying to get down to Walter Reed.

I have, my main concern is the cost really. He needs his three year check up along with medications for his nebulizer and monthly doses of Singulair. He was premature and I think he has lung issues from it. He has had croup 5 times in his life, has allergies, asthma and a yearly bout with a viral rash.

I think we will end up switching to standard just so we can see someone close for when there's a need for him to go in quick.

Btw- Good luck in April!

lauren2_00@yahoo.com · January 2012

noah-bear:
lauren2_00@yahoo.com:
Have you considered Standard? I switched to it when my husband deployed the first time and the closest MTF was about an hour and a half away. The co-pays are reasonable and it'll save you a lot of time and money spent in the car trying to get down to Walter Reed.
I have, my main concern is the cost really. He needs his three year check up along with medications for his nebulizer and monthly doses of Singulair. He was premature and I think he has lung issues from it. He has had croup 5 times in his life, has allergies, asthma and a yearly bout with a viral rash.
I think we will end up switching to standard just so we can see someone close for when there's a need for him to go in quick.
Btw- Good luck in April!

Thank you! I appreciate it. We try one more IUI next month since DH will finally be home from deployment, so keep your fingers crossed for me that it works. I would love not to drop over $6,000 on IVF.

I understand your concerns about cost. That's definitely something to consider when deciding whether or not to stay with Prime or switch over to standard. Don't be afraid to call your Tricare office or the regional office if you're unsure of costs. Most of the employees (in my experience) are willing to answer any questions you may have about the costs and benefits of Prime vs. Standard. Good luck and I hope your son feels better soon!

noah-bear · January 2012

lauren2_00@yahoo.com:

Thank you! I appreciate it. We try one more IUI next month since DH will finally be home from deployment, so keep your fingers crossed for me that it works. I would love not to drop over $6,000 on IVF.
I understand your concerns about cost. That's definitely something to consider when deciding whether or not to stay with Prime or switch over to standard. Don't be afraid to call your Tricare office or the regional office if you're unsure of costs. Most of the employees (in my experience) are willing to answer any questions you may have about the costs and benefits of Prime vs. Standard. Good luck and I hope your son feels better soon!

Then doubly good luck! I bet it'd be nice to get to keep that $6k. I have some friends going through both IUI and IVF. Fingers crossed that the first works for you!

Thanks for the advice! I've tried checking out the hnfs.com site, but it's very confusing. I haven't had the time to just sit down and try to go over it all. Maybe trying to call them would clear it up.

pesci12 · January 2012

noah-bear:

He's in Prime and has to go down to Walter Reed, which is aggravating because 1)I've never been there and 2) it's about an hour drive for us.

I just wish he could see a Dr closer to here.

Aw, that stinks. Sorry it's such a pain for you. If cost wasn't an issue, I would switch to standard.

Smudges*Mom · January 2012

noah-bear:
He's in Prime and has to go down to Walter Reed, which is aggravating because 1)I've never been there and 2) it's about an hour drive for us.
I just wish he could see a Dr closer to here.

Wow, where did you guys end up finding a place if Walter Reed is an hour away? WRNMMC isn't an hour from where I live in Alexandria.

Have you talked to a TRICARE rep about the chance of staying on Prime but being assigned a civilian PCM for your DS? Can your DS be seen where you are getting your prenatal care (provided you are on Prime and being seen at an MTF)?

My LO goes to the pediatrician at Fort Myer. We love the pedi there, he is fabulous! I don't know if you are anywhere near Arlington though.

Good luck finding a pediatrician for your DS.

Lissa832 · January 2012

If he's enrolled, call Walter Reed's family care clinic. If you call first thing in the morning, around 6, you'll get a same day appointment in all likelihood.

We're at Quantico, but we were assigned to Woodbridge, which was annoying. I switched to Standard, and have no regrets. The cost really isn't a issue, IMO. Well child check ups u til 5, I believe, are covered 100%. Your yearly GYN is also covered. You'll have a $300 family deductible, but no one person goes over $150 for the deductible. So even if the family hasn't hit $300, if your DS hits $150, he'll go into the cost share. Then you pay 15% of the Tricare allowed charges up to $1000 and then it's covered 100%.

Tricare covers cents to the dollar. My provider charged Tricare $290 for a visit I had. Tricare only allowed $48. It was considered my yearly visit, so I didn't get charged a dime, but my cost share would have been 15% of the $48, not $290.

Pregnancy is covered as well. I paid $33 total for my delivery. If you're admitted to the hospital for anything, you don't pay a percentage of that, but a daily rate which is around $17 I believe.

IMO, the added expense is worth the freedom.

Ilumine · January 2012

noah-bear:

lauren2_00@yahoo.com:
Have you considered Standard? I switched to it when my husband deployed the first time and the closest MTF was about an hour and a half away. The co-pays are reasonable and it'll save you a lot of time and money spent in the car trying to get down to Walter Reed.

I have, my main concern is the cost really. He needs his three year check up along with medications for his nebulizer and monthly doses of Singulair. He was premature and I think he has lung issues from it. He has had croup 5 times in his life, has allergies, asthma and a yearly bout with a viral rash.

I think we will end up switching to standard just so we can see someone close for when there's a need for him to go in quick.

Btw- Good luck in April!

This is not a snark...but the out of pocket costs (OOPC) for Standard - AS A FAMILY - can only reach $1000 a fiscal year (this includes what you pay as your yearly deductible).

And you ONLY pay 15%-20% of the provider's bill (as long as the provider takes TRICARE - and any provider who takes Medicare MUST by law take TRICARE payments) depending on if the provider is in the Network or Not.

Yes $1000 at once can be pretty expensive. But if HNFS is giving you a hard time changing your provider, then maybe its the best thing.

noah-bear · January 2012

Smudges*Mom:
noah-bear:
He's in Prime and has to go down to Walter Reed, which is aggravating because 1)I've never been there and 2) it's about an hour drive for us.
I just wish he could see a Dr closer to here.
Wow, where did you guys end up finding a place if Walter Reed is an hour away? WRNMMC isn't an hour from where I live in Alexandria.

Have you talked to a TRICARE rep about the chance of staying on Prime but being assigned a civilian PCM for your DS? Can your DS be seen where you are getting your prenatal care (provided you are on Prime and being seen at an MTF)?

My LO goes to the pediatrician at Fort Myer. We love the pedi there, he is fabulous! I don't know if you are anywhere near Arlington though.

Good luck finding a pediatrician for your DS.

We're up in North Potomac, MD. It's about a 40 minute drive for DH at 5am and worse as the day goes on.

We have to set up the online stuff to log in to change his PCM or DH has to go into the Tricare Service Center. He's finishing up orienteering and doing ACLS training today and tomorrow so he hasn't had time.

There is a doc nearby that a neighbors sister goes to (who is also on TriCare) so I know they'll be ok and work with us.

I know this can all be done, I'm just exhausted. I'm in a high risk pregnancy and getting the runaround trying to get injectables ( the P17 shots) that I have to start in a few weeks and getting my Dr covered.

noah-bear · January 2012

Thanks Lissa and llumine

(I have no clue why this is centered)

I do have a lot to research and learn about TriCare, I didn't know there was as much to it as there is. I'm going to tackle it all today hopefully and get DS in. With him being sick, it's not as easy to skip his nap for him so scheduling is tight, but i know we can do it.

I very much appreciate the advice and info about the deductibles. I had no idea what they were (I know, I'm bad) and that helps make me feel better about him going to Standard. If DH has time today he can run down to the Service Center and disenroll him from prime. Apparently the Service Center doesn't have a phone you can call? Convenient right? Lol

emolm · January 2012

hopefulmom81:
emolm:
If you know where to take him and feel he needs to be seen, then you should go.

While you're there, go to Tricare and submit a PCM change request for someone closer to your house. If they approve it, he's still Prime and you get what you want. If they don't approve it, then either switch to Standard or put your big girl panties on.
Did you see the phrase BGP somewhere and decide you wanted to use the phrase and just randomly busted it out here? OP had an honest question and it was completely unnecessary to be rude. Not cool.

I answered the question. Those are the options. We went through the same nonsense with trying to get our baby seen in a reasonable amount of time on base. It's not rude, it's just how it is.

emolm · January 2012

noah-bear:

We have to set up the online stuff to log in to change his PCM or DH has to go into the Tricare Service Center.

You should call to see if they'll let you make the change. We didn't need my husband to submit the request here so I'd imagine it's the same everywhere.

AnchoredByLove · January 2012

I feel your pain with Tricare! When we PCS'ed in August I called Tricare to switch from TriWest to TriNorth. When I told them my new zip code to get my new PCM, they told me "There's no one in the area. When you find someone who takes Tricare let us know so we can update our system." :-O !!!! I was so upset with them! I had to call doctor's offices in the phone book to ask who took Tricare Prime Remote... which was only 2 in the area. And of course they were the last ones I called. And so far I've had nothing but awful experiences with Tricare Prime Remote!!!! When gettting a referral for a knee injury that required an ER visit... first they referred me to the orthopedist/surgeon in the area that is known for doing horrible surgeries. When I asked to see a different doctor, one recommended by pretty much everyone in the area, they denied it saying they weren't in network. So they referred me to another doctor instead who was 45 min away from my home!!!! I called that office... and that doctor has been retired for 4 years!!!!!!!!! WTF Tricare?! Update your records!!!! Long story short, they eventually let me see the original doctor I requested. Ugh. And now I've been waiting 3 weeks for a referral to see a specialist. I wish I was still near at MTF because care was so much easier there.

( I hope you get answers soon!!!!!

Bluescarf · January 2012

Maybe this is just where we live? When I went in to the Tricare office itself on my base they told me that if your are a far distance away, and they consider I believe anything more that 30 minutes so, that you can then be referred to a civilian pcm closer to home. We may possibly move farther out and they said to let them know and we can fill out the necessary paperwork. Have you asked about that?

noah-bear · January 2012

With DS being sick we made some appts out at Walter Reed, already went to one, and doing a follow up. I do want to get him somewhere closer to home, but the drs we saw out there are really great and even let me e-mail them. Grr, why couldn't they have been icky? Lol

Anyway, we go back out on Wednesday (and DH will be with us) so we'll go out to the Tricare Service Center and take a name of the person we'd like to switch to DS's PCM.

Thank you everyone for advice. I'm in two battles with TriCare right now, one is for DS and one is for me to get my progesterone shots I need. They keep sending me to different companies with phone numbers that don't work. :-( I think all insurance's are difficult at times though.

TriCare makes my head hurt

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